Refractive kerato-lenticule extraction surgery (KLex), also known as "small incision lenticule extraction (SMILE)," or "smooth incision keratomileusis" (SILK), represents a significant advancement in refractive surgery with its minimally invasive approach and impressive success rates. Despite these advancements, postoperative infectious keratitis, though rare, poses a critical challenge and profoundly impacts visual outcomes. Unlike infections following surface ablation procedures, which benefit from direct drug penetration into the site of infection, KLex and LASIK face hurdles due to the depth of infection location. In laser-assisted in situ keratomileusis (LASIK), infections begin at the interface between the flap and the stromal bed, whereas in KLex, they occur within the stromal bed. This position of the infiltrate poses the challenge of inadequate drug penetration, making management more complex. This review explores the nuances of post-KLex infectious keratitis, delving into the incidence, predisposing factors, and pathophysiology. It also covers the common organisms causing the infection, clinical manifestations, and management strategies. By offering a comprehensive guide, this paper aims to furnish clinicians with the knowledge necessary for vigilant monitoring and timely intervention, thereby enhancing patient outcomes following KLex procedures.